Rehabilitation

William H. Shull, Jr. MD
Assistant Professor of Rehabilitation Medicine
Director of Neurotrauma Rehabilitation
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Rosette Plotkin, PhD
Clinical Neuropsychologist
Adjunct Assistant Professor of Rehabilitation Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

ARDS (Acute Respiratory Distress Syndrome) is a very complex condition during which the patient is very ill. There is a growing body of evidence that other organ systems (besides the lungs) may be affected during this critical illness. After ARDS, you may experience one or more of the following problems:

1. Physical problems: fatigue, insomnia, pain, weakness, poor appetite

2. Functional problems: balance, walking, driving, climbing stairs, self-care activities

3. Cognitive problems: attention, memory, math calculation, concentration, being organized

4. Emotional problems: depression, anxiety, nervousness, irritability, impulsivity

When you or your loved one was hospitalized with ARDS, your primary physician was probably a pulmonologist or critical care physician. These specialists are experts in the diagnosis and treatment of lung disease. It is important to have follow-up with the pulmonologist after ARDS so that your lung function can be monitored and treated if necessary.

Rehabilitation Medicine is a new field and rehabilitation doctors are referred to as physiatrists. They are board certified in Physical Medicine and Rehabilitation, and they hold M.D. or D.O. degrees. Just as in pulmonary medicine, rehabilitation physicians can specialize in different areas (e.g., neurological disorders, musculoskeletal disorders, sports medicine, spine and joint problems, cardiac and pulmonary rehab, amputation, etc.). A neurorehabilitation physician or physiatrist specializes in diagnosing and treating the physical, functional, cognitive, and emotional problems due to neurological disorders. In order to provide comprehensive treatment of these problems, medication treatment and a variety of specialists may be involved in the functional restoration process. Some of these specialists include:

1. Neuropsychologist: This is a type of psychologist who specializes in testing and treating persons with thinking (cognitive), language (speaking and understanding), and emotional problems, including depression, anxiety, and behavioral difficulties (e.g., anger management and impulsivity). They also provide counseling and psychotherapy for patients and their families. They hold Ph.D or Psy.D degrees. The difference between a neuropsychologist and a clinical psychologist is that the neuropsychologist is trained in the assessment and treatment of neurological and medical disorders, while the clinical psychologist works primarily with patients who have primary mental health problems.

2. Physical Therapist: This health professional delivers therapy to treat mobility problems, such as difficulty walking, painful injuries, and balance disorders, usually focusing on the spine, joints, and legs.

3. Occupational Therapist: This health professional delivers therapy to treat problems in self care and activities of daily living, such as grooming, dressing, bathing, toileting, bathroom mobility, kitchen management, and homemaking. Certain occupational therapists specialize in fine motor skills, hand injuries, visual problems, or community-level activities, such as driving and return to work/employment.

4. Speech-Language Pathologist (SLP): An SLP is a professional trained at the master’s or doctoral level in the prevention, evaluation, and treatment of speech (articulation, voice, fluency), language (spoken and written), and swallowing disorders. The SLP should be certified by the American Speech-Language-Hearing Association (ASHA) and licensed by the state, where required. For more information about communication and swallowing disorders and what an SLP can do for you, visit ASHA’s web site at www.asha.org/public/.

All of these professionals should work together as a team, which requires close communication among each other and with the neurorehab physiatrist. Although the earlier one seeks rehabilitation treatment, the faster functional restoration should occur, there is no time limitation for seeking help if problems persist. Some problems may get better with time, but learning ways to compensate for these problems during this time will improve function and quality of life. It is important to ask your pulmonary physician to refer you to a neurorehabilitation physiatrist so that the whole rehab process may begin and continue in a comprehensive and coordinated manner. A pulmonary rehabilitation program may only address the physical endurance, breathing, and functional problems. The best pulmonary rehab programs have emotional/behavioral components but they typically do not have cognitive therapy to address the cognitive problems and the emotional/behavioral support is usually in groups and not individualized enough for depression and anxiety. Make sure all your problems are being addressed...don't keep them to yourself. You have survived a catastrophic disorder and should not be ashamed if you have problems. Sometimes you can compensate for them but it may require the help of rehab professionals to restore your full functional capacity so you can get back to family responsibilities, work, play, and life in general.